Life Certificate to be Submitted by Pensioner Once a Year in November

ANNEXURE-XVII

(See para 15.1 page 11 of

CPAO's Scheme Booklet) 

Part-A (Every year)

LIFE CERTIFICATE

(To be submitted by Pensioner once a year in November)

Certified that I have seen the pensioner Shri/Smt./Ms._______________________________________ (Name of Pensioner) holder of Pension Payment Order No. _____________ and that he/she is alive on this date. 

1. Present address of the pensioner/family pensioner.
2. Telephone/Mobile number (if any).
3. E-mail Address (if any).

Name
Place:

Designation of Authorised Officer

Date:

Seal 

ACKNOWLEDGEMENT 

Life Certificate of Pensioner/Family Pensioner of Shri/Smt/Ms._________________________________ (Name of Pensioner) holder of Pension Payment Order No. ______________ has been received. 

Date:-

Signature ...................... 

Name ………………………….

Stamp of the receiving Bank branch

Source:- http://cpao.nic.in/pdf/life_certificate.pdf